Healthcare Provider Details

I. General information

NPI: 1932306867
Provider Name (Legal Business Name): WOMENS LIFE CENTER OF LUMBERTON PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2007
Last Update Date: 05/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 LIVERMORE DR
PEMBROKE NC
28372-7282
US

IV. Provider business mailing address

800 OAKRIDGE BLVD
LUMBERTON NC
28358-2330
US

V. Phone/Fax

Practice location:
  • Phone: 910-522-7220
  • Fax: 910-522-7302
Mailing address:
  • Phone: 910-738-2454
  • Fax: 910-671-9335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: DEBBIE GREENE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 910-738-2454